Newsweek, Feb. 3, 1997

CAN MARIJUANA BE MEDICINE?

THE CLAIMS ARE UNPROVEN, BUT MANY PATIENTS SAY THE DRUG HELPS THEM.

By Geoffry Cowley

Susan Nelson spent most of 1978 watching her husband, Don, retch almost constantly. His body fought so hard to expel the chemicals used to treat his testicular cancer that, after 18 months, his battered esophagus ripped, causing tissue damage that has plagued him ever since. A decade later, it was Susan's turn. She developed lymphoma in 1989, and she, too, underwent chemotherapy. But in four months of treatment, she vomited only once. Instead of heading for the bathroom when she felt a surge of nausea, she took matters into her own hand: she fired up a joint.

Susan Nelson is no dopehead. She grew up in a military family, and never even experimented with pot as a '60s teenager. But she wasn't about to relieve her husband's experience. The anti-nausea drug her doctor prescribed did wonders for her digestion, but it also lowered her inhibitions, causing inexplicable urges to throw plates and roll burning logs on the living-room floor. Smoking marijuana may have broken the law (she bought it from fellow patients), but it didn't break her dishes. "When I smoked it," she recalls, "you could still trust me."

Americans may frown on recreational pot smoking, but as recent votes in California and Arizona make clear, a lot of people favor leaving folks like the Nelsons alone. The states' initiatives won't have much practical effect (they free doctors to recommend marijuana without creating legal supplies of the drug). Still, the measures have revived an important and long-neglected question: does pot ever make good medicine? Federal drug-enforcement officials say the drugs is both useless and dangerous. They're challenging the new initiatives in court and vow to punish doctors who prescribe pot to their patients. But proponents claim marijuana can help control glaucoma, forestal AIDS-related wasting, ease the nausea brought on by cancer chemotherapy and counter the symptoms of epilepsy and multiple sclerosis. The claims are largely unproven, but they warrant some serious attention.

Marijunana's basic mode of action is well known. Several years ago, researchers discovered that the body makes a chemical closely resembling THC, the main active ingredient in cannabis, and that the brain has receptors designed specifically to receive it. The receptors are concentrated in the brain regions responsible for motor activity, concentration and short-term memory. As anyone who ever inhaled will attest, marijuana can disrupt all those activities.

The question is whether it can do anything else. For nearly three decades the government has listed marijuana as a "schedule I" drug, a designation reserved for substances with no apparent medical value and a high potential for abuse. Barry McCaffrey, director of the Office of National Drug Control Policy, stoutly defends that ruling, saying there is "no convincing scientific evidence" that marijuana offers benefits that a person can't get from approved prescription drugs.

Where glaucoma is concerned, McCaffrey has a point. It's well known that smoking marijuana can reduce pressure within the eye, a hallmark of the disease. But the drug may also reduce the blood supply to the optic nerve - the last thing a glaucoma sufferer needs - and it doesn't seem to prevent blindness. Even if marijuana could save eyes, smoking it enough would take extraordinary effort. "In order substantially reduce eye pressure," says Dr. Harry Quingley of Johns Hopkins University's Wilmer Eye Institute, "you'd have to be stoned all the time." When researchers tried dissolving THC in eye drops, they succeeded only in irritating people's eyes, but other compounds proved more useful.

as a result, glaucoma patients can now choose from a number of potent topical treatments. The latest, a once-a-day eye drop called Xalatan, is virtually free of major side effects.

Marijuana may not cure glaucoma, but it has other claims to respectability. People have used it for centuries to stimulate appetite, and an unknown number now use it to combat the wasting associated with AIDS. No one knows how much good it's doing - the drug-control agencies have recently thwarted studies intended to answer that question - but some experts suspect the benefits are modest. The wasting syndrome doesn't stem solely from a lack of appetite, says Dr. Donald Kotler, an immunologist at New York's St. Luke's-Roosevelt Hospital. The patient may have an intestinal infection that blocks the absorption of nutrients, or a neck tumor that interferes with swallowing.

Skeptics also note that the FDA has already approved several effective remedies for wasting. To stimulate appetite, patients can take Marinol, a synthetic version of THC that comes in pill form, or Megace, a premarketing studies, AIDS patients who took Megace for 12 weeks gained and average of 11 pounds, while those getting a placebo lost 21. Since AIDS takes a particular toll on muscle tissue, the FDA has also approved several muscle-building steroids (testosterone and its kin) as AIDS treatments. Patients with good insurance can also get synthetic human-growth hormone, a bone-and-muscle builder that costs $1,000 a month.

Yet as many patients have discovered, plain old pot may still have a valuable role. Keith Vines, a 46-year-old San Francisco prosecutor, considers himself a stalwart in the war on drugs. As an assistant district attorney, he has spent years putting street dealers in jail. As an AIDS patient, he has seen his body threaten to disintegrate. "Three years ago my ribs were protruding," he says. "I was terrified to get on the scale." He wanted to enroll in a study of human-growth hormone, but participants had to eat three meals a day, and he could hardly force down one. He tried several drugs - including Marinol, which often left him too blasted to function - but nothing worked until he joined a local buyers' club and started smoking pot. Once he took that leap, he qualified for the human-growth-hormone study, put on 45 pounds and managed to salvage his job. "Whithout marijuana," he says earnestly, "I would be dead."

Like AIDS-related wasting, the nausea from cancer chemotherapy is readily treated by prescription drugs. But those drugs are expensive, they don't always work and they're not always harmless. Their warning labels are littered with phrases like "hives," "impotence," "difficulty breathing." "tremors and rigidity" and "leukopenia" (a drop in white blood cells). Marijuana isn't riskfree - its smoke contains a number of carcinogens - but it's less toxic than many prescription drugs. There is no recorded instance of a death from overdose. And because people consume it one puff at a time, feeling the effects as they go, they can easily tailor their intake to their needs.

That's a big advantage for people with chronic pain or with spastic disorders such a multiple sclerosis. Whereas prescription drugs may zonk them out for the whole day, marijuana lets them respond directly to their symptoms. No one has conducted trials to gauge marijuana's genuine therapeutic effect on pain and spasm. But that doesn't much concern 39-year-old Andrew Hasenfeld, who was diagnosed with multiple sclerosis in 1980. He tried the prescription drug bactofen, but it never relieved the spasms, the stiffness, the sensation of "being all locked up." He restored to marijuana six months ago, at the urging of fellow sufferers in Amherst, Mass., and the result was dramatic. "There's no comparison with any drug I could buy in a pharmacy," he says.

Few people would argue that Andrew Hasenfeld, Keith Vines or Susan Nelson belongs behind bars. ("I'm already in a wheelchair," says Hasenfeld. "Isn't that enough?") Nad though recreational pot smokers can get involved with harder drugs, it's hard to see how easing one's nausea, wasting or muscle spasms could cause what the drug office describes as "a downward spiral of self-destruction." Still, federal regulatory policy can't rest entirely on individual testimonials. As McCAffrey argues in a forthcoming "myths and truth" position pare, "drug policy must be based on science, not ideology." Approving marijuana as a prescription drug would require organizing clinical trials, identifying appropriate uses and finding ways to regulate its cultivation and sale. Those aren't insurmountable obstacles; morphine has been used medically for years. But federal policy has long discouraged clinical research with marijuana. The drug-control office is now pledging that "any serious marijuana research request will be consider

ed." Perhaps that will begin to clear the smoke.